(See 'Voluntary cessation of intake' below.) In a survey of nurses’ experiences, hospice patients who stopped eating and drinking died an average of 10☗ days after stopping, and 85 percent of patients died within 15 days.LENGTH OF SURVIVAL AFTER STOPPING NUTRITION AND HYDRATION - In general, patients who go without nutrition or hydration in the context of a terminal illness only live for a short time. (See 'Use of artificial hydration' below.) Symptoms of thirst do not necessarily improve with artificial hydration in this patient population.
CATHOLIC TEACHING ON WITHHOLDING FOOD TO HASTEN DEATH SKIN
While clinicians commonly associate several signs and symptoms with dehydration and hypernatremia (eg, thirst, anorexia, nausea and vomiting, fatigue, and irritability) or hypovolemia (eg, diminished skin turgor, orthostatic hypotension, and dizziness), these symptoms may not be highly specific in terminally ill patients. (See "General principles of disorders of water balance (hyponatremia and hypernatremia) and sodium balance (hypovolemia and edema)".) These causes all result in total body water depletion and decreased renal function.ĭehydration (resulting from total body water depletion) and hypovolemia (due to loss of both salt and water, mainly from the extracellular space) may occur either separately or together. In addition, there may be a progressive accumulation of drugs (including opioids) and their metabolites, which can cause or exacerbate symptoms of fatigue, dizziness, myoclonus, sedation, and hallucinations which impair fluid intake. The dying process is usually characterized by diminished oral intake, partly due to diminished perception of thirst and hunger. (See 'Voluntary cessation of intake' below.)įLUID DEFICITS AT THE END OF LIFE - Fluid deficits in terminally ill patients are frequently multifactorial in etiology. Voluntary stopping of eating and drinking – Voluntary stopping of eating and drinking (VSED) is the self-initiated, intentional decision to stop drinking liquids and eating food for the specific purpose of causing death.This can be achieved by intravenous, subcutaneous (hypodermoclysis), dermal (dermoclysis), and rectal (proctoclysis) administration. Artificial hydration – Artificial hydration involves the provision of water or electrolyte solutions by any route other than the mouth.(See "Nutrition support in critically ill patients: Enteral nutrition" and "Inpatient placement and management of nasogastric and nasoenteric tubes in adults" and "Nutrition support in critically ill patients: Parenteral nutrition".)
Parenteral delivery can involve peripheral intravenous access or central venous access. Enteral approaches include nasogastric (NG), percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic gastrostomy jejunostomy (PEG-J), or gastrojejunostomy tubes.
This topic will address the role of artificial nutrition and/or hydration specifically as it applies to patients in palliative care who are in the last days or weeks of life.
Palliative services, including setting patient-centered achievable goals for medical care and aggressive symptom management, should be routinely offered alongside curative and disease-modifying treatments for patients with serious illnesses.
Patients receiving palliative care range from fully functional (especially if newly diagnosed with an incurable illness) to extremely limited with regard to their quality of life and prognosis. INTRODUCTION - Palliative care aims to relieve suffering in all stages of disease and is not limited to the end of life.
0 kommentar(er)
